Provider Demographics
NPI:1003325598
Name:CHOUDHURY, SALWA WADUD (PA-C)
Entity Type:Individual
Prefix:MS
First Name:SALWA
Middle Name:WADUD
Last Name:CHOUDHURY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1201 STONE ST
Mailing Address - Street 2:SUITE #3
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060
Mailing Address - Country:US
Mailing Address - Phone:810-985-5000
Mailing Address - Fax:810-985-3700
Practice Address - Street 1:1201 STONE ST
Practice Address - Street 2:SUITE #3
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060
Practice Address - Country:US
Practice Address - Phone:810-985-5000
Practice Address - Fax:810-985-3700
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-27
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5601008427363AM0700X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical